The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America

Abstract

Access to treatment for opioid use disorder (OUD) in rural areas within the United States remains a challenge. Providers must complete 8–24 h of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine for OUD. Over the last 4 years, we executed five dissemination and implementation grants funded by the Agency for Healthcare Research and Quality to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports, in rural primary care practices in different states. We found that obtaining the DATA 2000 waiver is just one component of meaningful treatment using MOUD, and that the waiver provides a one-time benchmark that often does not address other significant barriers that providers face daily. In this commentary, we summarize our initiatives and the common lessons learned across our grants and offer recommendations on how primary care providers can be better supported to expand access to MOUD in rural America.

Keywords:

• Primary care
• rural
• opioid use disorder

Acknowledgements

We would like to acknowledge the rest of our team members from our respective projects, including those at the University of Pittsburgh, the Pennsylvania Department of Human Services, the University of Utah, the University of North Carolina, the Oklahoma Department of Mental Health and Substance Abuse Services, the American Society for Addiction Medicine, the American Institutes for Research, TMF Health Quality Institute, the University of Colorado, and the University of New Mexico.

Author contributions

Evan Cole, Ellen DiDomenico, Sherri Green, Susan Heil, Linda Zittleman, and Julie Salvador conceived and designed the manuscript, and are principal investigators at their respective grantee sites where they are responsible for data collection, analysis, and interpretation of results that form the basis of the findings presented here. Tandrea Hilliard, Sarah Mossburg, Andrew Sussman, Jack Warwick, and John Westfall each contributed to data collection, analysis, and interpretation of results at specific grantee sites. All authors contributed to the writing of the manuscript.

Additional information

Funding

This work was funded by the Agency for Healthcare Research and Quality (AHRQ). AHRQ was not involved in the conceptualization or the writing of this manuscript.